HomeMy WebLinkAboutPermit Mechanical 2009-11-10
. Mechanical Permit A
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225 Fifth Street. Springfield, OR 97477 . PH(54 I )726-3753 . FAX(541)726-3689
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I DEPARTMENT USE ONLY
I Permit no.: t Cj - / (p Lf J
I Date: ) / /10 Ie) 7
This permit is issued under OAR 918-440-0050. Permits expire if workis not started within 180 days of issuance or if work is
suspended for 180 days.
I CATEGORY OF CONSliRUCTIOri!:"J "' "
I ffResidential 1 0 Government I 0 Commercial
I JOB SITE INFORMATION.':ANO;;[OCATION:C,>, '
I Job site address:.363 I PJ'l~ jJ,..,j..
1 Cit)~nn~lc4-J State:b(' 1 zIPC1)Lfn
I Reference: 1 Taxlot.:
I DESCRIPTION' OF WORK ,,,~
Ills1a.1l S'JnIA{") ~ J5C, ~I\"\-
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I F'ROPERTY OWNER, ',,:,~
1 Name Rt>\:l.tu+ '..+1 ~ C1(" I
1 Address: 3q~ f~' ~
1 city:~r~.e...i 01 r State: ~ 1 ZIP~L/JI
IPhone5l1~q?,~c:,' 1 Fax: - - .
. 1 E-mail: R\Q.N.Ln~Q:~u~.lI..b!-
This install'atI6n is being made on property owned by me or a
member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
Signature:
I CONTRACTOR INSTALLATION ' ~I
I Busine"name:Uf\r\Jpl1\ 'q -Pn-(..{ lh<. 1
1 Address:;:Y'J \ S Uf1~ \..00....\.1 I
City:H...l (':0 lUl I S'tat~: (") r r ZIP: q 1463
Phon~f)/':74{, lto21 I FaS/J"-7fu 91 a q
,I E-mail:
1 CCB license no.: ~ I
I Print name'""'j r ..P S h Q ~ f""-L () rI nt)y
I signature0 J/_ ~ .-/fX. {2M~
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440-2545-J (11/08/COM)
I ,. ' I FEE SCHEDULE
I Reside(ltial IQ~ I CMt Total
. $79~O cost
I First Appliance $1' 'fQ ~
!Furnace/burner including ducts aod vents
I Up to lOOk BTUlhr. I I $17.00 I $
lOver lOOk BTUlhr. $20.00 $
I Heaters/stoves/vents
I Unit heater $17.00 $
I Wood/pellet/gas stove/flue $38.00 $
I Repair/alter/add to heating appliance/
refrigeration unit or cooling system! $58.00 $
absorption system
I Evaporated cooler $13.00 $
I Vent fan with one duct/appliance vent $9.00 $
Hood with exhaust and duct $13.00 $
Floor furnace including vent $58.00 $
Gas pipinl(
One to four outlets I I $7.001 $
Additional outlets (each) $4.00 $
Air-handlinl( units, includinl( ducts
Up to 10,000 CFM I I $11.00 I $
Over 10,000 CFM $20.00 $
Compressor/absorption svslemlheat Pump
Up to 3 hp/100k BTU $17.00 $
Up to 15 hp/500k BTU $29.00 $
Up to 30 hpll ,000 BTU $43.00 $
Up to 50 hpll,750 BTU $57.00 $
Over 50 hpll,750 BTU $95.00 $
Incinerators
Domestic incinerator $20.00 I $
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I CommercIal
I Enter total valuation of mechanical system
and installation costs $_
I Enter fee based on valuation of mechanical system, etc. $
II\II.i~cellaneous fees ~lem' ~ ~=J
I Reinspection $58.00 $
I Specially requested inspections (per hr.) $58.00 $
I Regulated equipment (unclassed) $13.00 I $
I Each additional inspection: (I) $58.00 I $
1!4;JI:' , ,,'APPLICANT USE
I (A) Enter subtotal of above fees (or enter set
minimum fee of $ 79.001
I (B) Investigative fee (equal to [A])
I (C) Enter 12% surcharge (.12 x [A+B])
I (D) Scismic fee, 1% (.01 x [A])
I (E) Technology Fee (5% offAl)
I TOTAL fees and surcbarges (A'through E):
$ ')'1 ~::-
$
$ '1 iI-
$
$ 3' "!5-- I
$ '12- ~I
Building/Combination Permit
PERMIT NO: COM2009-01643
ISSUED: 11/10/2009
APPLIED: 11/10/2009
EXPIRES: 05/10/2010
VALUE:
..\.,
Status
.
Issued .
225 Fifth Street, Springfield, OR, _.
54]-726-3753 Phone. . .'_- .-'
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54]-726-3676 Fa~: r- ...;,>:.: ,;,.:, ',,~"X
54]-726-3769 Inspectioif Line . ".,\
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SITE ADDRESS;":- 303 18TH ~T;:
ASSESSOR'S PARCEL NO,: 1703362401100
CITY OF ~J:'K.ll~t.l'lJ'.,LD
Springfield TYPE OF WORK: Mechanical Only
,
Residential
TYPE OF USE: New
PROJECT DESCRIPTION: Split,system ,~eat pump- elect on separate permit
"
Owner:
Address:
. .. '. v...,.Ol.1l-'~1 ',~',l. v,:;:-......._.,l "'~~" '......t\.lll'--'''' 1........~....
PING R()JJERf'J '::i: j;,~II,}w ruies adup(ed by the Oregon Utility
303:N ]8TH Notification Center. Those rules are set forth
SPRINGFIELD OR ff7~;7j{R 952-001-0010 through OAR 952-001-
.. . -.. ~.
vVQ'V. IVU I,.ay VIoJ~""'" ..........I""'-'w.... (.,... .....~..-.
._ .calling thr eom'RA~1'ION ,
number fe, ,. _ _ '!! !
C t t Center is 1-800-332-2344). L'
on rac or " Icense
HARVEY & PRICE CO 77
Contractor Type
Mechanical
.... t. ~. _.... ..~. ,"04-.''''_ _
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, I BUlLDlNGINFORMA TION I
# of Units: " 'ro'f Stories:
Primary Occupancy Gronp: . H~lg'ht 'of Structure
Secondary Occnpancy Gronp:. Type of Heat:
Primary Construction Type NOTlOOJ Water Type:
Secondary Construction TYP"fHIS PERMIT, SHAL~[I1lPIP::~ THE WORK
# of Bedrooms: ..AUr@RIZED UNDE~"fflJS flt!R~rr IS NOT
"'COMMENCED OR IS ~[lll.\IJ~I1'P8R No
ANY 180 D~I'rfIWii~PMENT INFORMATION I
" ~
,I
Frontyard Setback:
Side I Selback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
"
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
~ -~.
I ~UBLIC IMPROVEMENTS I
Street Improvements: ,
-r "
Storm Sewer Available:'
Special Instruction:
Expiration Date
10/31120 I 0
Phone
541-746-1621
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
" j (: ~
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Sidewalk Type:
Downspouts/Drains:
, .
Notes:
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I Valuation Descriotion I
I,
,-
Description " Type of Construction
$ Per Sq Fl
or multiplier
Square Footage
or Bid Amount
. .
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Paee I of2
~
Value
Date Calculated
"
Status
Issued
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225 Fifth Street,Springfjeld, ORB :~S.' .
541-726-3753 Phone'" . ,. .. ',:
541-726-3676 Fax' , . .
. 541-726-3769 In~p.ec!ioIl'Line
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Fee Description /,-, ,;,: ...,
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+ 12% State Su'i'charge.'.:, :',
+ 5% Technology Fee
1st Appliance
'1."
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Total Amount Paid
~:.' , 1.11~~.;
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Amount Paid
$9.48
$3.95
$79.00
" $92.43
Total Value of Project
Fees P3idJ
I Plan Reviews I
Date Paid
CITY OF ~rKlj~\.J1'1J<,LD'
Building/Combination Permit
PERMIT NO: COM2009-0I643
ISSUED: ll!]0/2009
APPLIED: ] 1/]0/2009
EXPIRES: 05110120]0
VALUE:
11/10/09
11/10/09
11110/09
Receipt Number
2200900000000001276
2200900000000001276
2200900000000001276
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m, will be made the following
"'
work day.
I ~e(Juired Insnections I
Rough M~chanic~l: Prior to Cover
Final Mechanical: When all mechanical work is complete.
By signatnre, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify thaI' only contractors and employees who are in compliance with ORS 70] .005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction. ..
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Owner or Contracto'j-s'Signature""' ,c..
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Paee 2 01"2
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Date
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225'Fifih Street"r.',::.. i..' ':::: >.:
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S[iringfield, Oregon 97477,:'..:,:;',,::;.,..
541-726-3759 Phone ,.
,
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City of Springfield Official Receipt
Development Services Department
Public Works Department
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.' ..RE<::EI~1;i~t: '2200900000000001276
Job/Journal Number.'('~,' Desc~iption
COM2009-01643:, IstAppliance
COM2009-0I643' :;(,:<:+~.'fo Technology Fee
COM2009-0I643 ',' + i2%Siat<~uf!;harge
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Payments:
Type of Payment
CredilCard
~aid By
.:,TRESHAOCONNOER
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cReceint 1
Received By
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Page I of I
Date: 11/10/2009
Item Total:
Check Number Authorization
Batch Number Number How Received
054240 In Person
Payment Total:
1:43:13PM
Amount Due
79,00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43
11/10/2009